Role of private sector in Myanmar s health care system: Implications for health sector reform

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1 Role of private sector in Myanmar s health care system: Implications for health sector reform San San Aye, Yoshimi Nishino, Khaing Soe, Ko Ko Zaw, Yin Thet Nu Oo, Wai Wai Han, Than Tun Sein, Shakil Ahmed 06 July 2013

2 Main sources of health care in Myanmar: Public health facilities Private care Providers NGOs Private providers are involved in the provision of ambulatory care in some townships and institutional care in large cities

3 Background The Government of Myanmar and development partners considering various compulsory and voluntary social health insurance schemes and social assistance programs in order to achieve universal health coverage The options being considered include: increased tax-based financing, Township-based health protection scheme, Expansion of social health insurance and Private health insurance.

4 Private Health Equity Fund Trust Fund (330 Tsp) Township Based Health ProtecOon Scheme MCH Voucher Scheme Private Health Insurance Health Insurance Law 50 % 2022 Expansion of Social Health Insurance <5 % Increased tax based financing - 4 fold higher (330 Tsp) Social Assistants given by CBOs 2012 Donors (HSS)

5 Policy-makers need to understand the role and relative importance of public-and private-sector health care providers in the design, resource allocation and implementation of universal health coverage strategies

6 Objective: To assess the importance of private sector in providing outpatient and inpatient services for the treatment of common illnesses and hospitalisation Methods: A cross-sectional survey was conducted in two townships of Myanmar in 2011 Data were collected from 1,382 households with a population of 7,896 on out-of-pocket expenditure

7 Data Collection: Use of public and private health facilities for common illnesses and hospitalisation Expenditure for related health care Data Analysis: Descriptive Analysis Care seeking by sources of care Average expenditure for different categories

8 Findings For most recent episode of a common illness 61% of survey respondents reported seeing health care providers and 47% of them sought care from private clinics About 2.4% of the study population was hospitalised and private sector was the source of 28.7% of all hospital admissions

9 Utilization of health services for common illness by type of facility (1,569 cases) Traditional, MCH, 1% 2% RHC, 6% Sub- RHC, 11% Public Hospital, 9% Private Clininc, 47% Home, 24%

10 Common illnesses (out-patient) Mean expenses per visit (Kyat) Transportation (round trip) Consultation & drugs Other cost (Tests/meals) Total Home 142 (3.8%) 3096 (83) 455 (13.2) 3693 Hospital 8336 (41) (53) 1019 (16) RHC 1031 (32) 1349 (42) 824 (26) 3204 Sub RHC 2638 (54) 1874 (39) 3397 (7) 4849 MCH Centre 2463 (56) 1357 (31) 571 (13) 4391 Traditional Medicine 3534 (30) 6630 (57) 1474 (13) Private clinic 4715 (33) 9020 (62) 698 (5) USD = 974 Kyats, July 2013

11 Mean cost per hospitalization (Kyat) and number of admissions) Township hospital Station District Hospital Hospital Yangon General Hospital Private Hospital N Consultation Drugs Investigaction fees Surgical fees Meals (patient) Gift/Donation Transportation Others USD = 974 Kyats, July 2013

12 Findings Consultations at hospitals, private clinics and with traditional medicine practitioners were found to be the most expensive since these facilities are located only at the township level Average cost of outpatient services for common illness was USD and USD for the public and the private sectors respectively Average hospitalization cost per discharge, however, was much higher for the private sector (USD 920.9) than that in the public sector (USD )

13 Conclusions In Myanmar private sector plays an important role in health care delivery and a significant proportion of total health expenses is due to out-of-pocket expenses Achieving universal health coverage will probably be more effective and efficient if the Government considers inclusion of vibrant private sector in planning health care provision and delivery for the population The findings have implications in health financing and health systems policy-making and particularly in the health systems strengthening in Myanmar

14 Acknowledgement Department of Health Planning, Ministry of Health Department of Medical research, Ministry of Health UNICEF Myanmar Myanmar Maternal and Child Welfare Association Township Health Departments, Daik-U and Kyauktaga Health Systems Strengthening Unit, Nossal Institute for Global Health

15 Thank You